Insurance Verification Specialist

Description

Schedule: 6AM - 2PM - hybrid (3 days in office and 2 days remote) after 30 business days of in person training

Community Medical Services (CMS) is hiring an Enrollment Specialist. This role will complete verification of client eligibility on various, Medicaid, Medicare & Commercial Provider Portals. Maintain day to day enrollment and demographic processing in Community Medical Services Inc. EHR and EMR for all lines of business. Create, update and submit all Demographics to applicable Payers. Research rejected Claims related to member data and resolve discrepancies.

Provide necessary follow-up to resolve errors, this would include communication with Operations and Clinical staff.

As you join our mission to help those suffering from substance use disorders reclaim their lives, expect to thrive in a comfortable, welcoming, and fun environment where you are valued for the work you do, championed by passionate leaders, and equipped with the tools and ongoing training you need to achieve your goals.

Along the way, we’ll invest in your well-being through a benefits package for full-time employees that includes:

• Subsidized medical, dental, and vision insurance
• Health savings account
• Short and long-term disability insurance
• Life insurance
• Paid sick, vacation, and holiday time
• 401K retirement plan with match
• Tuition and CME reimbursement up to 100%
• Employee assistance program to support your mental health and wellness
• Ongoing professional development

Responsibilities:

• Verification of client eligibility on various Medicaid, Medicare & Commercial Provider Portals.
• Respond to inquiries, submitted to Departmental Inbox (Microsoft Outlook).
• Maintain day to day enrollment and demographic processing in Community Medical Services Inc. EHR and EMR for all lines of business.
• Identify opportunities and recommend actions to improve the efficiency and accuracy of processes.
• Perform audits and analyses on completed member data in core systems.
• Create, update and submit all Demographics to applicable Payers.
• Research rejected Claims related to member data and resolve discrepancies.
• Provide necessary follow-up to resolve errors, this would include communication with Operations and Clinical staff.

Requirements

Qualifications:

• High school diploma or equivalent.
• 3+ years of transaction processing, data reconciliation, membership records, or related managed care/healthcare experience.
• Experience in a managed care environment with provider information systems preferred.
• Must be comfortable with reviewing at least 1000k client records a month to validate insurance or client balances.
• Must be comfortable with reviewing client information in the 9 states, where business rules are different.

#CRPSF

About Community Medical Services

Community Medical Services (CMS) is a CARF-accredited addiction treatment program providing services in the form of outpatient medication-assisted treatment and one-on-one and group counseling to those seeking help with their opioid use disorder. Headquartered in Arizona with more than 70 treatment clinics in eleven states, CMS is dedicated to meeting the challenges presented by the growing opioid epidemic in communities where treatment is lacking.

Our Commitment

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sex, disability status, sexual orientation, gender identity, age, protected veteran status or any other characteristic protected by law. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Other Conditions

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.